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Severe Asthma in Children

Asthma affects approximately 5 million children in the United States. Of these, almost 200,000 wind up in the hospital, needing incubation and mechanical ventilation. These are the most severe cases of asthma, and while the numbers may be scary, they are improving every year as new medicines and testing helps to identify and treat severe asthma in children.

  1. Symptoms

    • The most common symptoms of asthma in children are cough, chest tightness or pain, shortness of breath, wheezing and, in more severe cases, vomiting that is not related to any other illness.

    Tests

    • The most common tests are PEF (peak expiratory flow), which measures how fast your child breathes, spirometry, which is only used in children 5 or older and shows both how fast your child breathes and how much air is moved when she breathes, a chest X-rays. Allergy tests may be performed if the doctor suspects that allergies may be to blame.

    Risk Factors

    • Common risk factors for asthma are allergies, obesity, tobacco smoke, heredity, low birth weight and living in an area with severe air pollution. If the mother has asthma, the chances of the child having severe asthma that lasts beyond childhood increases.

    Management

    • The purpose of asthma medicines in a child with severe asthma is to help the child lead a normal life, including sleeping, learning and playing.

    Treatment

    • Treatment will generally include a peak flow meter (to measure the ease of breathing for the child), a pump (also called a metered-dose inhaler), dry powder inhalers, a nebulizer (to deliver medicine in a mist) and oral medicines (such as pills and tablets).

    Rescue Medicines

    • Short-acting bronchodilators are often called "rescue medicines" because they are taken during an asthma attack in order to stop the symptoms within minutes. They are generally delivered through a metered-dose inhaler. The most common is abuterol; however, pibuterol and levalbuterol are also available.

    Long-Term Treatment

    • There are five main types of drugs that are used in long-term treatment: corticosteroids that help to reduce the inflammation, such as fluticasone, mometasone, triamcinolone, budesonide, flunisolide, and beclomethasone; combination inhalers that contain long-acting bronchodilators and inhaled corticosteroids; cromolyn that help to prevent asthma attacks; theophylline, a form of bronchodilator; and leukotriene modifiers, such as montelukast and zafirlukast.

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